DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,
Palakkad, Kerala
Dated this the 18th day of November, 2011
Present : Smt.Seena.H. President
: Smt.Preetha G Nair, Member
: Smt.Bhanumathi A.K, Member Date of filing: 03/12/2009
CC/159/2009
C. Kandan,
S/o Late Chinna,
Joint Secretary,
Kerala Consumer Protection Center, - Complainant
Vallathu House, Thekkeparambu,
Puduppariyaram (P.O),
Palakkad
(Party in person)
Vs
1. The Chairperson/Charge Officer,
Kudumbasree Community Development Society,
Puduppariyaram (P.O),
Palakkad
(Party in person) - Opposite parties
2. The Panchayath Secretary,
Puduppariyaram Grama Panchayath,
Puduppariyaram (P.O),
Palakkad
(Party in person)
O R D E R
BY SMT. SEENA. H, PRESIDENT
Complainant's mother was a member of an insurance policy named 'Arogya Insurance Policy' organised by the joint efforts of the Government and Local Self Government. As per the policy, complainant's mother has paid premium to the tune of Rs. 33/-. Complainant's mother was hospitalised on 03/10/2007. On 18/10/2008 she died. As per the policy terms, member of the policy is entitled to claim maximum of Rs. 30,000/- in connection with treatment and hospital expenses. An amount of Rs. 50/- per day for one week is available as daily expenses of bystander. Benefits of the policy is available to the children of the member also. Complainant herein who is the son of the insured has met the hospital and treatment expenses of his mother. Complainant submitted the claim form along with bills for an amount of Rs. 9,260/-. There was no response from the opposite parties. Subsequently as per the request under RTI Act, 2005, complainant was informed that the government has cancelled the said programme. According to the complainant, the act of opposite parties in not informing about the cancellation of the programme even though premium was received and non return of premium and placing the reasons only at the time of claiming the insurance amount, amounts to deficiency in service on their part.
2nd opposite party filed version contenting the following. As per the contentions of 2nd opposite party, Arogya Insurance policy was organized by the joint efforts of State Government, Local Self Government and the members of the policy. Accordingly each party has to pay Rs.33/- towards the premium amount. The tie up was with ICICI Lombard. Accordingly, 2466 persons from the panchayath remitted Rs.33 each. Total amount of Rs.2,466/- was paid to ICICI Lombard institution in 2006 itself. Subsequently as there was no payment from the part of the Govt., ICICI returned the deposited amount by way of Demand Draft. As per the Govt. Instruction the said amount was deposited in a separate account maintained by the Panchayath. More over the said facts were informed by the government to the members through medias. 2nd opposite party filed an additional version stating that there was no policy coverage at the time of the death of the complainant's mother. Further Government of Kerala is the real introducer and implementer of the said insurance scheme and the complaint filed without impleading Government of Kerala is bad for non joinder of necessary parties. Hence according to 2nd opposite party complainant is liable to be dismissed.
The evidence adduced by the complainant consists of the cheif affidavit and Ext. A1 to A10. 1st opposite party has not filed any affidavit. 2nd opposite party filed chief affidavit. Complainant was cross examined as PW1.
Matter was remanded back from Hon'ble State Commission directing to permit all the parties to adduce evidence in support of their contentions. There after additional version and affidavit was filed by 2nd opposite party. 2nd opposite party also filed application for cross production of the policy and receipt for payment of premium by complainant, for which complainant filed affidavit stating the said documents were not issued to the complainant. Complainant was cross examined by 2nd opposite party.
Issues to be considered are:
1. Whether there is any deficiency in service on the part of the opposite parties?
2. If so, what is the relief and cost entitled to the complainant?
Issues I & II
Heard complainant and 2nd opposite party and perused the available evidence on record. 2nd opposite party in the earlier version has admitted that Arogya Insurance Policy was organized by the joint efforts of state government, local self government and the members of the policy. 2nd opposite party has no case that the mother of complainant has not paid the Rs.33/- as premium to the panchayath. 2nd opposite party themselves has admitted that Rs.33/- each collected from 2466 persons was paid to ICICI Lombard. As per Ext. A1 complainant has given application for availing the policy on 20/01/2006. Complainant has claimed hospitalization expenses for the year 2007 and also for the year 2008. Amount claimed for the year 2007 is Rs.2,371/- and amount claimed for the year 2008 is Rs.5594.50. No evidence is adduced by the complainant to show that policy if any existed, has been renewed in the year 2008. So even if a policy is existing for the year 2006-07, amount for the year 2008 cannot be claimed.
2nd opposite party has contented that the said policy was withdrawn by the state government as it was not found to be beneficial. The short question to be decided is whether the 2nd opposite party has the responsibility to intimate the said decision of the government to the members who has paid the premium. A specific question was put by the complainant in the questionnaire that whether information regarding the non continuance of the policy was informed to the members and if so how it was informed. 2nd opposite party has given answer stating that it is only an implementing agency of the government and the government and the ICICI Lombard has the responsibility to intimate the same to the members and government has intimated the same through medias. 2nd opposite party has further contented that complaint is bad for non joinder of necessary parties without impleading the Kerala government and ICICI Lombard. It is true that opposite parties has no responsibility for payment of insurance claim as it was withdrawn by the government. In our view 2nd opposite party being a part of the said programme of the government is responsible for giving intimation to the members. It is admitted by 2nd opposite party that government's decision has been intimated to 2nd opposite party. 2nd opposite party has not taken any steps to publish it either in newspaper or even in the notice board of the panchayath. Further no documentary evidence is forthcoming from the 2nd opposite party to prove their contentions that government has cancelled the said programme, ICICI Lombard has returned the amount and it has been maintained in a seperate account as directed by the government etc. 1st opposite party has not adduced any evidence in their favour. Hence we are of the view that both opposite parties are liable to compensate the complainant for the deficiency in service on their part.
Issue No:2
The amount claimed by the complainant for the medical expense for the year 2007 is Rs.2,371/-. Hence loss if any suffered by the complainant on account of the deficiency in service is Rs.2,371/-. Hence we are of the view that compensation of Rs.2500/- will meet the ends of justice.
In the result complaint partly allowed. Opposite parties are jointly and severally directed to pay complainant an amount of Rs. 2,500/- as compensation along with Rs. 500/- as cost of the proceedings.
Order to be complied within one month from the date of receipt of order failing which the whole amount shall carry @ 9% per annum from the date of order till realization.
Pronounced in the open court on this the 18th day of November, 2011
Smt. Seena. H
President
Smt. Preetha. G. Nair
Member
Smt. Bhanumathi. A. K
Member
A P P E N D I X
Exhibits marked on the side of the complainant
Ext. A1 – Insurance application form
Ext.A2 – Photo copy of letter issued by the Kerala Consumer Protection Centre to the 2nd opposite party dated 04/07/2009
Ext.A3 – Copy of letter issued by the 1st opposite party dated 16/07/2009
Ext.A4 – Copy of application dated 30/07/2009 under R I Act.
Ext.A5 – Copy of reply letter sent by the 2nd opposite party dated 25/08/2009
Ext.A6 – Copy of application dated 10/09/2009 under R I Act
Ext.A7 – Copy of reply from 2nd opposite party dated 08/10/2009
Ext.A8 – Copy of claim application submitted by complainant
Ext.A9 – Copy of letter issued by the 2nd opposite party dated 08/10/2009
Ext.A10- Copy of application sent by the complainant under R I Act dated 23/07/2010.
Exhibits marked on the side of the opposite parties
Nil.
Witness examined on the side of the complainant
PW1 – C. Kandan
Witness examined on the side of the opposite parties
Nil.
Cost allowed
Rs. 500/- allowed as cost of the proceedings.
DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,
Civil Station, Palakkad 678001, Kerala
Dated this the 25th day of March, 2010
Present: Smt.Seena.H, President
Smt.Preetha.G.Nair, Member
Smt.Bhanumathi.A.K, Member
C.C.No.159/2009
C.Kandan,
S/o.Late Chinna,
Joint Secretary,
Kerala Consumer Protection Center,
Vallathu House, Thekkeparambu,
Puduppariyaram(P.O),
Palakkad. - Complainant
(Party in person)
Vs
1. The Chairperson/Charge Officer,
Kudumbasree Community Development Society,
Puduppariyaram(P.O),
Palakkad.
(Party in person)
2. The Panchayath Secretary,
Puduppariyaram Grama Panchayath,
Puduppariyaram(P.O),
Palakkad. - Opposite parties
(Party in person)
O R D E R
By Smt.Seena.H, President
Complainant’s mother was a member of an insurance policy named ’Arogya Insurance policy’ organised by the joint efforts of the Government and Local Self Government. As per the policy complainant’s mother has paid premium to the tune of
Rs.33/-. Complainant’s mother was hospitalised on 03/10/2007. On 18/10/2008 she
died. As per the policy terms, member of the policy is entitled to claim maximum of Rs.30,000/- in connection with treatment and hospital expenses. An amount of Rs.50/- per day for one week is available as daily expenses of bystander. Benefits of the policy is available to the children of the member also. Complainant herein who is the son of the insured has met the hospital and treatment expenses of his mother. Complainant submitted the claim along with bills for an amount of Rs.9,260/-. There was no response from the opposite parties. Subsequently as per the request under RTI Act, 2005, complainant was informed that the govt has cancelled the said program. According to the complainant, the act of opposite parties in not informing about the cancellation of the program even though premium was received and non return of premium and placing the reasons only at the time of claiming the insurance amount, amounts to deficiency in service on their part.
Opposite parties were appearing in person. 2nd opposite party filed version. 1st opposite party has not filed any version. As per the contentions of 2nd opposite party, Arogya Insurance policy was organized by the joint efforts of State Government, Local Self Government and the members of the policy. Accordingly each party has to pay Rs.33/- towards the premium amount. The tie up was with ICICI Lombard. Accordingly, 2466 persons from the panchayath remitted Rs.33 each. Total amount of Rs.2466/- was paid to ICICI Lombard institution in 2006 itself. Subsequently as there was no payment from the part of the Govt., ICICI returned the deposited amount by way of DD. As per the Govt instruction the said amount was deposited in a separate account maintained by the Panchayath. More over the said facts were informed by the Government to the members through medias. Hence 2nd opposite party is not liable for any payment to the complainant.
The evidence adduced consists of affidavit of complainant. Exts.A1 to A8 marked on the side of the complainant. Both opposite parties has not filed any affidavit. No documentary evidence on the part of opposite parties.
Now the issues for consideration are;
Whether there is any deficiency in service on the part of opposite parties?
If so, what is the reliefs and cost complainant is entitled to?
Issues 1 & 2:
Heard the complainant and perused the available evidence on record. It is not in dispute that the complainant’s mother has paid Rs.33/- towards her contribution for becoming a member of the Arogya Insurance policy of ICICI Lombard. 2nd opposite party has contented that the Government has cancelled the said program. ICICI Lombard has returned the amount deposited by way of DD and the said amount is maintained by 2nd opposite party in a separate account as directed by the Government. 2nd opposite party has not adduced any documentary evidence in support of any of their contentions. Opposite parties has not produced the order of the Government cancelling the program or document pertaining to receipt of the amount from ICICI Lombard or any news paper daily informing the member that the said program is cancelled. Even no affidavit was filed by the opposite parties. In these circumstances, the evidence adduced by the complainant stands unchallenged. In our view, if the said program is cancelled, a member paying his contribution is entitled to be informed about its cancellation also. A mere information through media is not at all enough. Further the amount has also to be refunded. A member bearing the hospital expenses under the belief that the amount can be claimed by way of insurance cannot be made to suffer. Opposite parties being the machineries of the Government and 2nd opposite party being a party in the said policy is bound to provide information to the complainant. The act of opposite parties amounts to deficiency in service on their part. It is not proper directing the opposite parties to pay the insured amount as the program was cancelled. Hence we allow the complaint and direct opposite parties to pay Rs.5,000/- as compensation for the deficiency in service.
In the result complaint is partly allowed. Opposite parties is directed jointly and
severally to pay Rs.5,000/- (Rupees Five thousand only) as compensation to the
complainant within one month from date of receipt of this order failing which the ordered amount shall carry interest @ 9% p.a from the date of order till realisation.
Pronounced in the open court on this the 25th day of March, 2010
Sd/-
Seena.H,
President
Sd/- Preetha.G.Nair,
Member
Sd/- Bhanumathi.A.K, Member
Appendix
Exhibits marked on the side of complainant
Ext.A1 – Insurance application form
Ext.A2 – Photo copy of letter dt.04.07.09
Ext.A3 – Copy of letter dt.16.07.09
Ext.A4 – Copy of application dt.30.07.09 under RTI Act.
Ext.A5 – Copy of reply dt.25.08.09
Ext.A6 - Copy of application dt.10.09.09 under RTI Act
Ext.A7 - Copy of reply dt.08.10.09
Ext.A8 – Copy of claim application submitted by complainant
Exhibits marked on the side of opposite parties
Nil
Cost (Not allowed)
